Reframing the Conversation

Article by guest author Eric Anderson


Last month, The Hill published an article written by Mayo Clinic physicians Gregory J. Gores, M.D. and Robert B. Diasio, M.D. in response to President Barack Obama and Vice President Joe Biden’s recent Cancer Moonshot initiative. If the moonshot, an effort to accelerate cancer research, is possible, Gores and Diasio believe it will take a multi-disciplinary, collaborative effort.

Highlighting Mayo Clinic’s role in facilitating the creation of Cologuard®, a “noninvasive, multi-target stool DNA screening test for colorectal cancer,” the physicians maintain:

“The success of the Cancer Moonshot depends on the nation’s ability to foster this same commitment to patient-centered, collaborative innovation at every stage of action.”

The term “patient-centered” suggests a move away from self-invested institutional goals, such as capital motivations or national rankings, but “patient” still presents an individual defined by constraints being used by our institutions to identify, differentiate, and standardize. The term’s use in the article isn’t intended to alienate individuals who are unable to receive care through Mayo Clinic, or carve out a niche market. But ideologies attached, for better or worse, to “patient-centered” and alternative phrasings such as “human-centered design” and “customer-focused” can easily slip into the insular trappings of jargon. So how can we reach beyond the limitations of our agreed upon language and honestly confront a disease that is, for lack of a better word, relentlessly inclusive?

At Transform 2016, Mayo Clinic’s David Ahlquist, M.D. and Kevin T. Conroy, Chairman, President and Chief Executive Officer of Exact Sciences, the company that commercialized Cologuard®, will be joined by Diana Redwood, Ph.D. to present a case study that evaluated the accuracy of a multitarget stool DNA test compared with fecal immuno-chemical testing for hemoglobin, for detection of screening-relevant colorectal neoplasia in Alaska Native people. Dr. Redwood, the Senior Epidemiologis at the Alaska Native Tribal Health Consortium, is acutely knowledgeable of the access and cultural issues associated with colonoscopy screenings within the Alaska Native communities. The challenge of offering screenings to a population that has among the world’s highest rates of colorectal cancer is compounded by the fact that more than half of all Alaska Native people reside in remote communities with limited access to endoscopic services.

Are the Alaskan Native people represented in the case study patients? Participants? Or does their unique situation present them as outliers, a trendy term loaded with positive and negative connotations? These types of arguments that focus on phrasing can be cast off as trivial. But it is important to be aware of how we address those who fall outside of our health care system’s traditional channels, those who may become part of the discovery process, and, most of all, those who are in need of care.

Join the conversation September 14-16 at Transform 2016 hosted by the Mayo Clinic Center for Innovation. Bring questions. Bring ideas. Help us find the words that not only reflect our best intentions, but words that have the potential to make change possible.